The Government Accountability Office (GAO) has published this report describing nonfederal efforts to help achieve health information interoperability. The GAO defines EHR interoperability is the ability of systems to exchange electronic health information with other systems and process the information without special effort by the user, such as a health care provider. The initiatives profiled include efforts to create guidance related to health data standards, encourage the adoption of certain health data standards or policies that facilitate interoperability, and operate networks that connect EHR systems to enable interoperability.  While some initiatives are making their products or services available at no cost, others are charging a fee for their products or services based on the type of entity using the product or service (e.g., individual physician or hospital) or the amount of data exchanged. Similarly, over half of the initiatives were using varying approaches to facilitate patient access to and control over their health information.

The 18 initiatives examined were:

  • Argonaut Project
  • California Association of Health Information Exchanges (CAHIE)
  • Carequality
  • Center for Medical Interoperability (C4MI)
  • CommonWell Health Alliance
  • ConCert by Healthcare Information and Management Systems Society (HIMSS)
  • eHealth Exchange
  • eHealth Initiative (eHI)
  • Electronic Healthcare Network Accreditation Commission (EHNAC)
  • Healthbridge
  • Healthcare Services Platform Consortium (HSPC)
  • Identity Ecosystem Steering Group (IDESG) Healthcare Committee
  • Integrating the Healthcare Enterprise (IHE) USA
  • Kansas Health Information Network (KHIN)
  • National Association for Trusted Exchange (NATE)
  • Open ID Health Relationship Trust (HEART) Working Group
  • Statewide Health Information Network of New York (SHIN-NY)
  • Substitutable Medical Applications and Reusable Technologies (SMART) on Fast Healthcare Interoperability Resources (FHIR)

The GAO identified the five top challenges to interoperability:

  1. Insufficiencies in health data standards
  2. Variation in state privacy rules
  3. Accurately matching patients’ health records
  4. Costs associated with interoperability
  5. The need for governance and trust among entities, such as agreements to facilitate the sharing of information among all participants in an initiative.

The Department of Health and Human Services provided technical comments on a draft of this report, which GAO incorporated as appropriate.

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